Trajectories of self-management and independence in youth with spina bifida: Demographic predictors of growth

Abstract

Aim: The purpose of this study was to examine the trajectories of condition and independent living self-management in youth with spina bifida (SB).

Methods: A diverse sample of adolescents and young adults (AYAs) with SB completed the Adolescent/Young Adult Self-Management and Independence Scale (AMIS-II) across four time points. Parents reported on demographic characteristics including age, sex, race/ethnicity, and family income. Growth in self-management and its subscales (condition and independent living) were estimated using linear mixed-effect models as a function of respondents' demographics.

Results: This study included 99 respondents age 18 to 27 years old. About half were female (52.5%) and White (52.5%); 15.2% were Black, and about a third were Hispanic/Latino (32.3%). Eighty-seven AYAs (87.9%) had myelomeningocele. The lesion level was 31.3% sacral, 48.5% lumbar and 18.2% thoracic. A third of the families earned less than 50K. Overall, self-management growth was dependent on age, sex, and race/ethnicity, but not income. Growth in condition self-management depended on sex; only males demonstrated increasing growth ( $\hat{\beta }$ = 0.11, p < 0.001). Black participants endorsed higher increasing total and condition self-management when compared with White ( $\hat{\beta }$ _diff = 0.17 and 0.17, respectively, both p < 0.05) and Hispanic/Latino ( $\hat{\beta }$ _diff = 0.18 and 0.21, respectively, both p = 0.02) respondents.

Conclusion: This study provides evidence of differences in growth of self-management by demographic/social determinants of health. Possible reasons for differences are discussed. Predictors of changes in self-management behaviours over time in young adults with SB can identify subgroups in need of further study.

Keywords: adolescents; independence; self-management; spina bifida; trajectory; young adults.